Neurobehavioral status check
Facility: Overland Park Reg Med Ctr
Billing Code: 96116 (CPT)
- CPT Billing Code: 96116
- Insurance Median: $92
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.42x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $220.6 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Amerigroup | $89 | 40% |
| United | $89 - $265 | 40% |
| Healthyblue | $91 | 41% |
| Medicaid / KanCare | $92 | 42% |
| Unicare | $93 | 42% |
| Aetna | $93 | 42% |
| Home State Health Plan | $279 | 126% |
Consumer Guidance & Cost Commentary
For the CPT code 96116, "Neurobehavioral status check," the facility in Overland Park, KS, has a median negotiated rate of $92.00 across seven payers, with individual rates ranging from $89 to $279 depending on the insurance plan. This commercial rate is significantly higher than the Medicare benchmark of $220.60, which serves as the federal baseline for evaluating hospital pricing markups. While commercial rates often average 200% to 300% of Medicare, this specific code shows a lower multiplier, suggesting a relatively efficient contract structure compared to typical commercial pricing. However, patients should note that cash-pay options are not listed for this service, meaning the facility is not offering a direct discount for self-pay patients who might otherwise benefit from paying the full cash price if their insurance negotiated rate exceeds it.
To minimize costs, patients should verify whether their specific insurance plan falls within the lower end of the reported range, as rates vary from $89 to $279 across different carriers. Since the facility is an acute care hospital with a proprietary ownership structure, it is advisable to contact the billing department directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% for upfront payments. Additionally, because over 80% of hospital bills contain errors, patients should request a detailed, itemized statement rather than accepting a summary bill, ensuring that no services were unbundled or double-charged. Finally, if a patient receives care from an out-of-network provider at this facility, they may be protected from balance billing under the No Surprises Act